Our Latest
Stage 6 Customer: St. Jude Medical Center
After leading the charge of St. Joseph's Health System's
"Perfect Care" initiative, St. Jude sets the bar even
higher by becoming the network's first Stage 6 hospital.
St.
Jude Medical Center (Fullerton, CA) is no stranger to quality
improvements. As a member hospital of St. Joseph's Health System,
the facility has long been a champion of 'Perfect Care,' the parent
organization's efforts to enhance clinical practices in service of
safer, more timely, evidence-based care delivery. Now, St. Jude has
another feather to add to its cap, as the facility recently became
the first in its network to achieve Stage 6 EMR adoption recognition
from HIMSS Analytics.
According to Teresa Frey, RN, it's the hospital's day-by-day efforts
of reexamining and redesigning care processes which have laid the
groundwork for its success. And she ought to know: as St. Jude's
director of clinical excellence, Frey is responsible for bridging
the gaps between I.T., quality, and clinical outcomes, as well as
overseeing the hospital's risk management, infection control, and
CMS reporting efforts.
"Although we're very proud of reaching Stage 6, I think we all
felt pretty well prepared for it. Sometimes, it's easy to forget how
far we've come, when we're living in the day-to-day," Frey
says. "By following the tenets of 'Perfect Care,' we've done so
much more than just replace a paper system. We've automated nearly
every clinical department in the hospital, and asked our providers
to change everything about the way they document care. And we've
done it by taking one project at a time, and always staying true to
our mission."
Perfecting
Results with 'Perfect Care'
Over the past several years, Frey has seen a number of quantifiable
improvements resulting, at least in part, from St. Jude's commitment
to using I.T. "We've been seeing benefits from working with
many cutting-edge technologies in our care areas, and I.T. has
certainly been a big part of that. For example, we've seen a 58%
decrease in medication errors—down
to .03%—since implementing
CPOE and Bedside Medication Verification (BMV)," she says.
"We now have 77% CPOE utilization, and we require it with any
physician who completes more than 200 orders per month. With BMV,
we've been careful to emphasize that the purpose of this tool is to
improve quality, not get work done faster. Today, our nurses are
comfortable relying on BMV, and very aware of how important it is
for avoiding adverse medication events. They truly depend on
it."
The MEDITECH system has also helped St. Jude's nurses to make great
strides with pressure ulcer prevention, by properly documenting and
tracking patient skin conditions, beginning at the point of
admission. "We built reminders into the software, about
double-checking patients for skin conditions in accordance with our
'Four Eyes' campaign, so we could catch and record these problems
early," says Frey. "We've seen a definite decrease in our
ulcer rates, because nurses are now documenting prevention measures
more effectively, right at the patient bedside. These results came
about, in large part, thanks to our truly outstanding nurse leaders,
who worked together with our I.S. team to determine the best ways
our technology could support the bedside nursing efforts."
Frey notes that the hospital has also been able to prevent instances
of Ventilator Associated Pneumonia (VAP), one of the most common and
costly hospital-acquired infections. "Our Critical Care Unit (CCU)
nursing leadership developed Rapid Improvement Event Visual
Management boards, for outside of every CCU bed. We've actually had
zero VAPs since the CCU implemented the process changes supported by
our electronic system back in November of 2009," says Frey.
"Furthermore,
we've been able to build visual tools into our documentation, to
ensure that our staff always complies with our VAP protocols. Having
an electronic system has made it so much easier to measure overall
infection rates, as well as staff performance of process measures,
to make sure we stay on the right track."
Setting
the Stage for Other Hospitals
For other hospitals pursuing Stage 6, Frey recommends a
well-planned, collaborative approach, with plenty of up-front
support from executive leaders. "Our Chief Medical Officer,
Michael Marino, DO, was particularly helpful in communicating to our
staff, and guiding us down the correct path. He assisted us in
getting the key stakeholders on board at the get-go, right alongside
our physicians and nurses," she says.
"But even though we had executives on our side, we were also
mindful about keeping the feedback loop open, especially with
clinicians, to be sure we didn't go stale. And we didn't expect to
get everything done all at once; be patient and take on all of your
I.T. projects in stages, a step at a time."
Frey adds that having clinicians leading clinicians is also very
important to secure buy-in and establish a sense of shared purpose.
"Our I.T. team consists of almost all nurses, which has been
very helpful in terms of forming strong bonds with our staff,"
she says. "Having an understanding of where clinicians are
coming from, and what they need to do their jobs effectively, has
been critical to our success. We've all been embracing technology
for a long time; I don't think any of us can ever imagine going
back."